BACKGROUND: We compared hernia recurrence rates in patients undergoing primary elective inguinal hernia repair at general hospitals with the Shouldice Hospital in Ontario, Canada. METHODS: We conducted an administrative data analysis of persons who underwent inguinal hernia repair in Ontario, Canada from 1993-2007. Risk of recurrent hernia repair was estimated according to hospital type and volume, using Cox proportional-hazards regression models. RESULTS: Recurrence risk in the lowest volume quartile was 5.7%, compared to 3.9% at high volume general hospitals and 1.1% at the Shouldice hospital. Compared to persons who had surgery at the lowest volume hospitals, hernia recurrence among Shouldice Hospital patients was substantially lower after adjustment for confounding variables (hazard ratio 0.18, CI (0.16 to 0.19), P <0.001). CONCLUSIONS: Persons who had elective primary inguinal hernia repair at the Shouldice Hospital had a substantially lower risk of recurrence than those treated at general hospitals, including high volume general hospitals.

BACKGROUND: We compared hernia recurrence rates in patients undergoing primary elective inguinal hernia repair at general hospitals with the Shouldice Hospital in Ontario, Canada. METHODS: We conducted an administrative data analysis of persons who underwent inguinal hernia repair in Ontario, Canada from 1993-2007. Risk of recurrent hernia repair was estimated according to hospital type and volume, using Cox proportional-hazards regression models. RESULTS: Recurrence risk in the lowest volume quartile was 5.7%, compared to 3.9% at high volume general hospitals and 1.1% at the Shouldice hospital. Compared to persons who had surgery at the lowest volume hospitals, hernia recurrence among Shouldice Hospital patients was substantially lower after adjustment for confounding variables (hazard ratio 0.18, CI (0.16 to 0.19), P <0.001). CONCLUSIONS: Persons who had elective primary inguinal hernia repair at the Shouldice Hospital had a substantially lower risk of recurrence than those treated at general hospitals, including high volume general hospitals.